Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:47:09Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MargareteReginattoGiacomini.pdf: 2673689 bytes, checksum: 26438120dfcc7521140bab509eb60121 (MD5) / Made available in DSpace on 2018-08-22T13:47:09Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MargareteReginattoGiacomini.pdf: 2673689 bytes, checksum: 26438120dfcc7521140bab509eb60121 (MD5) Previous issue date: 2017-06-26 / The objective of the present study was to delineate the epidemiological profile of pregnant women diagnosed with HIV/aids, syphilis and hepatitis B and C, notified in 2015, in a tertiary care regional referral service. As specific objectives: to present the epidemiological profile of the pregnant women notified in 2015 to the group responsible for the Maternal and Child Care Line of the hospital where the research was carried out, and to prepare a newsletter aiming at helping the visibility of the data to list the priorities of the team's actions. This is a cross-sectional retrospective study performed at a reference hospital in the central region of Rio Grande do Sul. Data collection took place in November and December 2016 and January 2017, through consultation in the system and notification forms of the Nucleus of Hospital Epidemiological Surveillance. From the survey, 179 cases of STI were identified in pregnant women in the year 2015. The age of women ranged from 15 to 41 years. The provenance of the pregnant women showed that many are coming from small municipalities of the central region of Rio Grande do Sul, considering that this hospital is a reference for this region. The product resulting from this work consisted of two articles of a newsletter, widely distributed and disseminated in the service in which the research was developed. As benefits, after the collection and analysis of the data, the results obtained were presented to the service, which allowed the knowledge of the situational diagnosis that could guide the planning of surveillance actions, prevention and control of the vertical transmission of STIs in municipalities of the 4th CRS, since HUSM is a reference in the hospital service for the region. / O presente trabalho teve por objetivo geral delinear o perfil epidemiológico das gestantes com diagnóstico de HIV/aids, sífilis e hepatites B e C, notificadas no ano de 2015, em um serviço de referência regional de atenção terciária. Como objetivos específicos: apresentar o perfil epidemiológico das gestantes notificadas no ano de 2015 ao grupo condutor da Linha de Cuidado Materno Infantil do hospital onde desenvolveu-se a pesquisa, e elaborar boletim informativo visando auxiliar a visibilidade dos dados para elencar prioridades de ações da equipe. Trata-se de um estudo transversal retrospectivo realizado em hospital de referência da região central do Rio Grande do Sul. A coleta de dados ocorreu de novembro e dezembro de 2016 e janeiro de 2017, por meio de consulta no sistema e fichas de notificação do Núcleo de Vigilância Epidemiológica Hospitalar. Do levantamento realizado, foram identificados 179 casos de IST em gestantes no ano de 2015. A idade das mulheres variou de 15 a 41 anos. A procedência das gestantes evidenciou que muitas são advindas de municípios de pequeno porte da região central do Rio Grande do Sul, tendo em vista que este hospital é referência para esta região. O produto resultante deste trabalho constou de dois artigos e boletim informativo, amplamente distribuído e divulgado no serviço no qual desenvolveu-se a pesquisa. Como benefícios, após o término da coleta e análise dos dados, os resultados obtidos foram apresentados ao serviço, o que permitiu o conhecimento do diagnóstico situacional que poderá balizar o planejamento de ações de vigilância, prevenção e controle da transmissão vertical das ISTs, nos municípios da 4ª CRS, visto que o HUSM é referência no serviço hospitalar para a região.

Magister Artium (Psychology) - MA(Psych) / The aim of the study was to explore the socio-cultural influences in decision making involving sexual behaviour among adolescents in Khayelitsha, Cape Town. Cultural beliefs associated with adolescents' decision to become sexually active were explored, as well as the social norms influences involved in adolescents' sexual behaviour. The theoretical framework used for the study was Bronfenbrenner's ecological systems theory of development. The results indicated that adolescent pregnancy was perceived as unacceptable behaviour although found widespread in communities. Social influences such as peer influence, low socioeconomic status, alcohol use and lack of parental supervision were found to play a role in adolescents' risky sexual behaviour. Cultural beliefs, cultural myths and social norms were identified as socio-cultural influences that endorsed issues such as gender disparities, which made adolescent mothers vulnerable. Findings from this study suggest that female adolescents are faced with sexual behaviour complexities. / South Africa

L'épidémiologie des infections sexuellement transmissibles (IST) à Mayotte est peu documentée notamment chez les femmes enceintes (FE) et la connaissance des déterminants favorisants les IST sur l'île dans un contexte socio-économique et sanitaire très particulier est nécessaire. Les objectifs de ce travail étaient d'estimer les fréquences et facteurs de risque associées au VIH, au VHB, et à la syphilis, d'étudier la vaccination anti-VHB et de décrire les connaissances, attitudes, croyances et comportements liées aux VIH/SIDA-IST chez les FE. Une étude transversale prospective a été réalisée auprès de 671 FE suivies dans les centres de Protection Maternelle et Infantile (PMI) de Mayotte. Aucun cas de séropositivité au VIH n'a été observé. La prévalence de l'antigène HBs du VHB était de 3,4% et celle de la syphilis active était de 2,1%, mais la prévalence de l'infection au VHB et de la vaccination anti-VHB était respectivement de 35.5% et 18.6%. L'infection par le VHB était associée au lieu de naissance (Comores), à des facteurs comportementaux et à des antécédents d'IST. La syphilis était plutôt associée au manque d'éducation et aux antécédents d'IST. La vaccination anti-VHB était associée à des déterminants sociodémographiques. L'étude socio-comportementale a montré qu'il existe une bonne connaissance du VIH/SIDA-IST chez les FE malgré la pratique de certains comportements sexuels à risque. Ce travail a permis de dresser un état des lieux du VIH et des IST, et de leurs déterminants chez les femmes enceintes à Mayotte, et permettra la mise en place de méthodes de prévention adaptées à ce contexte / The epidemiology of sexually transmitted infections (STIs) is poorly documented in Mayotte especially among pregnant women (PW) and knowledge of determinants that increased STI in the island, and in this particular socio-economic and health situation, is needed. The objectives of this study were to estimate the frequency and risk factors associated with HIV, HBV, and syphilis, to study the HBV vaccination and describe the knowledge, attitudes, beliefs and behaviors related to HIV/AIDS-STIs in PW. A prospective cross-sectional study was conducted among 671 PW followed in Mayotte public prenatal clinic (Protection Maternelle et Infantile (PMI)) services. No case of HIV seropositivity was observed. The prevalence of HBsAg of HBV was 3.4% and of active syphilis was 2.1%, but the prevalence of HBV infection and HBV vaccination was respectively 35.5% and 18.6%. The HBV infection was associated with birthplace (Comoros), behavioral factors and history of STIs. Syphilis was rather associated with lack of education and history of STIs. The HBV vaccination was associated with sociodemographic determinants. The socio-behavioral study showed that there is a good knowledge of HIV/AIDS-STIs in PW despite the practice of some risky sexual behaviors. This work has helped to draw up an update of HIV and STIs, and their determinants among PW in Mayotte, and could lead to the development of prevention methods adapted to this context

Sexually transmitted infections (STIs) have important consequences for individuals and society. Extensive literature has shown that various individual factors impact STIs. However, much less is known about their structural causes and how they affect sexual behavior and sexual network formation. In the first two chapters of this dissertation, I investigate how sex ratios and ethnic divisions affect sexual activity and the spread of STIs. In the third chapter, I analyze the effect of ethnic-based romantic homophily on STIs. I provide a brief description of each chapter below. Chapter 1. We extend a theory of fidelity in a two-sided economy, and empirically discriminate between different rationales of sexual network formation by testing their implications for how sex ratios affect sexual activity, relationship stability, and the spread of sexually transmitted diseases in men versus women. We use a unique individual-level dataset in combination with census data from England and Wales, a setting where adult women outnumber adult men. Exploiting variation in cohort/ethnicity/region-specific sex ratios as a quasi-natural experiment, we find that a decrease in sex ratio imbalance decreases sexual infidelity and the number of serial partners, and increases the likelihood of safe sex. This in turn reduces the likelihood of acquiring a range of sexually transmitted infections and diseases, including chlamydia, gonorrhoea, genital warts, and herpes. Consistent with the rationale underlying the formation of egalitarian (in)fidelity networks, the effects of the sex ratio on sexual activity are larger for men compared to women, while its effects on sexual diseases are larger for women compared to men. The causality of these effects is established using classical and recent instrumental variables approaches and various robustness checks. For falsification, we show that sex ratios have no impact on several "atheoretical" health conditions, such as Parkinson's disease, chronic lung disease, heart attack, stroke, and diabetes, which do not arise from sexual interactions. Chapter 2. In societies organized around distinct racial and ethnic groups, limited communication between these groups might increase the search cost of sexual partners outside of own group, leading to racially segregated sexual networks and low risks of sexually transmitted diseases. At the same time, because sexual infidelity is more likely to be discovered when the cheated-upon individuals are co-ethnics, individuals in multiracial societies might find it cheaper to select sexual partners from diverse ethnic groups to hide their infidelity, which would lead to large interethnic sexual networks and high risks of STIs. We test these conflicting hypotheses by analyzing the causal effect of neighborhood-level racial diversity on sexual activity and STIs, using unique individual-level data from England, Wales, and Scotland. We find that individuals residing in multiracial neighborhoods have a greater number of sexual partners and are more likely to be infected with a wide range of STIs than their counterparts residing in more racially homogeneous neighborhoods. We use traditional and new instrumental variables approaches and various robustness checks to establish causation. Analyzing mechanisms, we find that within racially diverse neighborhoods, individuals who select sexual partners from diverse racial groups are more likely to be infected with STIs, holding the number of partners and other individual characteristics fixed. For falsification, we conduct a reverse-placebo test showing that racial diversity has no effect on a wide range of health conditions that do not arise from sexual interactions. From a policy perspective, our analysis implies that policies that promote racial and ethnic integration are likely to reduce unhealthy sexual activity and the spread of STIs in racially heterogeneous societies. Chapter 3. A classical hypothesis in social network theory holds that central individuals are more likely to receive and spread information than are their peripheral counterparts. We test this hypothesis in the context of sexual networks and sexually transmitted diseases, using data from the United Kingdom. Romantic homophily - the tendency to select sexual partners with similar ethnic background - is used as a measure of the extent to which an individual is peripheral in a sexual network. We find that more sexually homophilous individuals have a lower risk of sexual infections. This effect is causal, and larger for women, Whites, and heterosexuals.

Background: Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members’ opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). Methods: In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. Results: Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM “never” discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them “at least once weekly” with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% “never”) and most with transgender network members (27.1% “at least once weekly”). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. Conclusions: Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. Trial registration: The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020) on January 4, 2017. / National Institutes of Health / Revisión por pares

No description available.

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p <.01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79–8.04), partner concurrency (4.42, 1.19–16.40), and participant alcohol (4.71, 1.82–12.17) or drug use (5.38, 2.22–13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01–7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use. / Revisión por pares

Indiana University-Purdue University Indianapolis (IUPUI) / The research ideas included in this dissertation are motivated by a large sexually trans mitted infections (STIs) study (IU Phone study), which is also an ecological momentary assessment (EMA) study implemented by Indiana University from 2008 to 2013. EMA, as a group of methods used to collect subjects’ up-to-date behaviors and status, can increase the accuracy of this information by allowing a participant to self-administer a survey or diary entry, in their own environment, as close to the occurrence of the behavior as possible. IU Phone study’s high reporting level shows one of the benefits gain from introducing EMA in STIs study. As a prospective study lasting for 84 days, participants in IU Phone study undergo STI testing and complete EMA forms with project-furnished cellular telephones according to the predetermined schedules. At pre-selected eight-hour intervals, participants respond to a series of questions to identify sexual and non-sexual interactions with specific partners including partner name, relationship satisfaction and sexual satisfaction with this partner, time of each coital event and condom use for each event. etc. STIs lab results of all the participants are collected weekly as well. We are interested in several variables related to the risk of infection and sexual or non-sexual behaviors, especially the relationship among the longitudinal processes of those variables. New statistical models and applications are established to deal with the data with complex dependence and sampling data structures. The methodologies covers various of statistical aspect like generalized mixed models, mul tivariate models and autoregressive and cross-lagged model in longitudinal data analysis, misclassification adjustment in imperfect diagnostic tests, and variable-domain functional regression in functional data analysis. The contribution of our work is we bridge the meth ods from different areas with EMA data in the IU Phone study and also build up a novel understanding of the association among all the variables of interest from different perspec tives based on the characteristic of the data. Besides all the statistical analyses included in this dissertation, variety of data visualization techniques also provide informative support in presenting the complex EMA data structure.

Thesis (MPH.) -- University of Limpopo, 2016 / BACKGROUND: In Botswana, women and girls continue to be disproportionately affected by HIV/AIDS. According to the UNAIDS in 2009, 170 000 of the estimated 300000 adults living with HIV or one quarter of the population aged 15 and over were women. HIV prevalence trend among pregnant women (Botswana Sentinel Surveillance 2001-2009) aged 15-49 years attending antenatal in public clinics is 31.8%. The national HIV prevalence amongst the women surveyed has shown a decline of prevalence from 36.2% in 2001 to 30.4% in 2011. AIM OF THE STUDY: The aim of the study was to determine the perceptions of women of reproductive age in Nkoyaphiri clinic, Mogoditshane village towards the use of female condom (FC). METHODS: A descriptive cross-sectional design was used on a sample of 125 women of reproductive age in Nkoyaphiri clinic in Botswana. A self-administered questionnaire written in both English and Setswana were given to 125 women of reproductive age. Their responses were coded, cleaned and entered into SPSS version 21.0 software for analysis. FINDINGS: About 92% of women of reproductive age heard about FC, more than half (64.8%) of respondents reported that they do not know how to use FC, and 88% have never used FC. The results had shown that a higher percentage (88%) of respondents have never ever used FC compared to (12%) that have used it. Most participants 46.4% believed that FC can prevent unwanted pregnancies, the Sexually Transmitted Infections (STI) and HIV/AIDS 42.4%. The results also show that 18.4% of respondents often use female condom inconsistently, while 3.3% cited it as their current contraceptive method. CONCLUSION: The results of this study shows that the level of FC use is lower (12%) among respondents, compared to 88% who never used FC. This shows that majority of women had never used FC. This results show that a lot still needs to be done in promoting the use of FC and strategies should be designed to send information to all individuals. Lack of knowledge on the use of FC contributes to lack of use of FC among women.

Orientador: Camila Marconi / Resumo: A microbiota vaginal normal é composta predominantemente por Lactobacillus spp. que conferem proteção contra infecções por patógenos, por meio da produção de ácido lático, peróxido de hidrogênio e bacteriocinas. Diferentemente, a vaginose bacteriana (VB) é caracterizada pela substituição da microbiota de Lactobacillus spp. por bactérias anaeróbias em sua maioria. A VB é a alteração de microbiota vaginal mais comum em mulheres de idade reprodutiva, acometendo aproximadamente 30% dessa população. Além disso, a VB é fator de risco para aquisição de infecções sexualmente transmissíveis (IST). Diversas características da população já foram associadas à VB, como idade, etnia, comportamentos sexual e de higiene. Entretanto, a real composição da microbiota vaginal só foi possível em 2011 com estudo utilizando o sequenciamento de nova geração do gene bacteriano RNA ribossômico 16S. Foi demonstrado que o microbioma vaginal pode ser classificado em cinco tipos de comunidades bacterianas (community-state types, CST). Quatro dessas CSTs tem predomínio de Lactobacillus: L. crispatus (CSTI), L. gasseri (CST II), L. iners (CST III) e L. jensenii (CST V), enquanto que a CST IV apresenta grande diversidade bacteriana e engloba a maioria dos casos de VB. Apesar de quatro CSTs apresentarem predomínio de Lactobacillus, o papel protetor da CST III, dominada por L. iners, contra aquisição de IST tem se demonstrado menor que os demais. Embora os estudos de microbioma tenham possibilitado conhecer me... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The normal vaginal microbiota is predominantly composed of Lactobacillus spp. which confer protection against pathogen infections through the production of lactic acid, hydrogen peroxide and bacteriocins. Differently, bacterial vaginosis (BV) is characterized by the replacement of the microbiota of Lactobacillus spp. by anaerobic bacteria for the most part. BV is the most common vaginal microbiota alteration in women of reproductive age, affecting approximately 30% of this population. In addition, BV is a risk factor for the acquisition of sexually transmitted infections (STIs). Several characteristics of the population have already been associated with BV, such as age, ethnicity, sexual and hygiene behaviors. However, the actual composition of the vaginal microbiota was only possible in 2011 with study using the new generation sequencing of the bacterial 16S ribosomal RNA gene. It has been shown that the vaginal microbiome can be classified into five types of community-state types (CST). Four of these CSTs have a predominance of Lactobacillus: L. crispatus (CSTI), L. gasseri (CST II), L. iners (CST III) and L. jensenii (CST V), while CST IV shows great bacterial diversity and involve most cases of BV. Although four CSTs have a predominance of Lactobacillus, the protective role of CST III, dominated by L. iners, against IST acquisition has been shown to be lower than the others are. Although microbiome studies have made it possible to know better the relationship between bact... (Complete abstract click electronic access below) / Mestre